Download - Mark Graban - Talk at Masaai Imai Event
Healthcare Kaizen
Mark Graban• President, Constancy, Inc.
• Chief Improvement Officer, KaiNexus
• Faculty, Lean Enterprise Institute
Author: Lean Hospitals
(2nd edition, November 2011)
Healthcare Kaizen(Released June 27, 2012)
© 2012, Constancy, Inc. & Mark Graban/Joe Swartz
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Kaizen
Kai = Change
Zen = Good
Hospital Kaizen Example
Why Kaizen in Healthcare?
• Safety• Quality•Waiting Times• Staff Morale• Cost
5
Dr. Berwick’s Call for Kaizen (1989)
• ”Continuous
Improvement as an Ideal in Health Care” – Kaizen = “the continuous
search for opportunities for all processes to get better”
Dr. Donald BerwickFounder, Institute for Healthcare Improvement
Former Administrator, Medicare and Medicaid (CMS)
Citation: Berwick, DM, “Continuous improvement as an ideal in health care,” New England Journal of Medicine, 1989 May 25;320(21):1424-5.
Where is the Kaizen Spirit?
“This sounds a lot like common sense. You mean everyone isn’t doing this?”
- KOMO FM Radio Host
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We’ve Made Some Progress
ThedaCare, University of Michigan
Greg Jacobson, MD
“Imai's book KAIZEN opened me up to a new world to me. My medical training had taught me about medicine: how to take a history, how to work up a patient, and how to treat disease. Healthcare is more than that… we are here to care for patients and to address all of their needs. That requires understanding that problems exists with the overall system. Kaizen offers a systematic and complete approach for doing meaningful improvement work in which everyone can be involved.”
Emergency Medicine Physician
CEO, KaiNexus
Principles of Kaizen
Why Kaizen?
“… emphasizes morale-boosting benefits and positive employee participation over the economic and financial incentives…”
- Masaaki Imai
Why Healthcare Kaizen?
• Scientific method for improvement• Simple solutions, big impact• Alternative to cost-cutting and
layoffs• Put your mind before your wallet
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“I feel like a robot.”
Do Work Improve WorkTwo Jobs at
Toyota
Do Work
Improve Work
Do Work Improve WorkTwo Jobs in a Hospital
Do Wor
k
Improve Work(You know if there’s nothing else to do
and if we don’t send you home)
“What Sets Us Apart?”
“Every Toyota team member is empowered with the ability to improve their work environment. This includes everything from quality and safety to the environment and productivity. Improvements and suggestions by team members are the cornerstone of Toyota's success.”
Suggestion Box = FAIL?
Six Sigma
Adapted from: “The Toyota” Way Fieldbook, Liker and Meier
Very fewLarge issues
FewMedium issues
ManySmall issues
MgmtKaizen
LeanEvent
Daily Kaizen
Different Levels of Kaizen
PDCA / PDSA
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•Plan•Do •Study•Adjust
Daily Kaizen Process
1.Find
2.Discuss
3.Implement
4.Document
5.Share
Find
Discuss
Implement
Document
Share
Basic Idea Card• Standardized Card in Use
– Prompts staff through the problem solving process
Visual Idea Board1 2 3 4
Nursing Unit Cards
Completed Idea Card
Coaching on Idea Cards
Source: Healthcare Kaizen
Toyota Benchmark
90%
The Role of Leaders?
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What Can We Do as Leaders?
• Ask for Kaizens–Help create time
What Can We Do as Leaders?
• Ask for Kaizens–Help create time
• Lead by example – participate–Get involved – coach, mentor, lead–Teach root cause problem solving–Follow the PDCA / PDSA process–Go to the gemba
“Kaizen is for Everybody” (Imai)
32Source: Healthcare Kaizen
“From the Janitor to the CEO”
Source: Healthcare Kaizen
What Can We Do as Leaders?
• Ask for Kaizens–Help create time
• Lead by example – participate–Get involved – coach, mentor, lead–Teach root cause problem solving–Follow the PDCA / PDSA process–Go to the gemba
Go to the Gemba
“Toyota managers should be sufficiently engaged on the factory floor that they have to wash their hands at least three times a day.”
- Taiichi Ohno
“Gemba is for Everyone”
“…Kaplan tours the hospital daily looking for problems and solutions. Everyone is encouraged to look for changes to make work more efficient.” - Virginia Mason CEO Gary Kaplan
Why Gemba?
Januar
y
Febru
ary
Mar
chApril
May
June
July
August
Septe
mber
Octob
er
Novem
ber
Decem
ber
Januar
y0
40
80
Patient Satisfaction
Patients (Gemba)
Walkway over tracks
ExecutiveOffices
Parking Garage
What Can We Do as Leaders?
• Ask for Kaizens–Help create time
• Lead by example – participate–Get involved – coach, mentor, lead–Go to the gemba–Teach root cause problem solving–Follow the PDCA / PDSA process
• Recognize and celebrate kaizen
Documenting & Sharing Improvements
• What was the problem?
• What was changed, improved, or implemented?
• What were the benefits?
• Who was involved?
Kaizen “Wall of Fame”
“Creativity Before Capital”
Source: Healthcare Kaizen
Patient Focus (NICU)
Source: Healthcare Kaizen
Clinical Improvement
Source: Healthcare Kaizen
Franciscan Participation
2011 Since 20070%
10%
20%
30%
40%
50%
60%
46%56%
% People Participating
# of Recorded Kaizens
Franciscan Savings Impact
Before / After Data from Children’s Medical Center Dallas Lab
Scores out of 5 (5 being highest) Before Lean
12 Months After Starting Lean
3. I have the opportunity to do what I do best every day.
3.11 3.928. I feel free to make suggestions for improvement.
2.84 3.48
10. I feel secure in my job. 2.32 3.4213. Stress at work is manageable. 2.43 3.2317. I am satisfied with the lab as a place to work.
2.51 3.4318. I would recommend my work area as a good place to work to others.
2.38 3.46
Grand Average 2.96 3.69
A Kaizen Culture:
Q&A / Contact Info
• Email: [email protected]• Blog: www.LeanBlog.org • Twitter:
www.twitter.com/MarkGraban • Books:–www.LeanHospitalsBook.com–www.HCkaizen.com